Q. I would like to ask you a question regarding lowering cholesterol. I am 39 years old. When I had my annual blood examination (c/o our office) my cholesterol was 220. My doctor told me to watch my diet. I brought it down to 204 in 5 weeks, but he still told me to take pravastatin. I do not feel comfortable doing this. I think I can lower my blood cholesterol some more by adopting lifestyle changes watching my diet some more and adding exercise to my routine and that I don’t need medications. Of course, I will talk to my doctor about this, but don’t you think this is the right step? Incidentally, I am not overweight.
— “Mario Salcedo”
A. What you have in mind is certainly sensible because the initial step in lowering blood cholesterol level especially in people like you whose cholesterol level is only borderline (normal is less than 200 mg/dl) consists simply of lifestyle modifications. Besides, pravastatin along with the other statins, although very effective in lowering blood cholesterol level, are not exactly innocuous.
A high blood cholesterol level is, very often, simply the result of eating food that is rich in cholesterol and saturated fat. Consequently, a high cholesterol blood level can sometimes be brought down to normal by just adhering to a low-fat diet.
However, hypercholesterolemia is not merely a dietary problem. There are other factors associated with the condition including advancing age, genetic make-up, obesity, sedentary lifestyle, excessive alcohol consumption, certain diseases such as diabetes mellitus, hypothyroidism, liver disease, and the intake of particular drugs such as birth control pills and thiazides. Thus, often, hypercholesterolemia cannot be controlled by diet alone, other lifestyle modifications and drugs may have to be employed. In your case, maintaining your weight at the present normal level, engaging in a regular exercise program (which you intend to do) and refraining from alcohol will certainly help. But if the lifestyle changes you intend to adopt do not work, you could consider taking cholesterol-lowering drugs.
At present, the most widely used cholesterol lowering drugs are the statins, and pravastatin is one of them. The other members of this group of drugs include atorvastatin, fluvastatin, lovastatin and simvastatin. The statins block the production of cholesterol by the body and facilitate the removal of low density lipoproteins or LDL (bad cholesterol) from the bloodstream.
Statins are routinely prescribed for people who have known heart and blood vessel disease secondary to atherosclerosis because scientific research has already established that regular intake of statins reduces the mortality and cardiovascular morbidity rates in these patients. They are also now being increasingly given to people with high blood cholesterol and other risk factors for heart disease even if these people do not have heart disease. This is because more recent studies have shown that statins improve survival and reduce the risk of major cardiovascular and cerebrovascular events in these people.
Statins though, are not harmless. They have adverse effects and should thus be taken only under the supervision of a physician. The more severe of these adverse effects include myopathy (i.e., muscle disease), hepatotoxicity (liver damage), peripheral neuropathy, impaired heart contraction and autoimmune diseases.
Likewise, statins can decrease blood cholesterol level to below normal and studies indicate that people with low cholesterol level have higher risk for cancer (lung and blood), respiratory and digestive diseases, violent death (suicide and trauma), and hemorrhagic stroke.
Lastly, it is certainly good that you intend to talk to your physician about how you intend to bring down your blood cholesterol level. Surely, he is the person who is in the best position to advise you on how you can bring and maintain you blood cholesterol to a normal level.
By EDUARDO GONZALES, MD